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Fungal keratitis: changing pathogens and risk factors.
Cornea 2009; 28(6):638-43C

Abstract

PURPOSE

To describe changes in demographics and pathogens for fungal keratitis cases diagnosed at the Massachusetts Eye and Ear Infirmary.

METHODS

Patient demographics, clinical and laboratory findings, treatment and outcomes of 46 cases of culture-proven fungal keratitis diagnosed from January 2004 through November 2007 were compared with 23 cases of fungal keratitis previously collected over a similar period from January 1999 through November 2002.

RESULTS

During 2004-2007, the rate of fungal keratitis was 1.0 cases per month, an increase from the baseline rate of 0.5 cases per month during 1999-2002. The proportion of cases caused by filamentous fungi increased from 30% (1999-2002) to 65% (2004-2007) (P = 0.01). Soft contact lens wear accounted for 41% of fungal keratitis cases in 2004-2007, as compared with 17% in 1999-2002. The majority of patients (70%) received oral antifungal treatment in addition to topical amphotericin B and natamycin. Seventeen patients (40%) required therapeutic keratoplasty. Patients with a history of corneal transplant had the highest rate of therapeutic keratoplasties (67%) and had the poorest visual outcome (40% counting fingers or less). In the contact lens group, 94% of patients maintained vision of at least 20/40 and only 12% required surgery to control the infection.

CONCLUSIONS

There has been an increase in fungal keratitis in the Boston area and a change in the causative pathogens and risk factors for infection. Filamentous fungi now account for the majority of fungal keratitis cases, whereas yeasts were the predominant pathogen in the past. Soft contact lens wear is currently the most common risk factor for development of fungal keratitis.

Authors+Show Affiliations

Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19512908

Citation

Jurkunas, Ula, et al. "Fungal Keratitis: Changing Pathogens and Risk Factors." Cornea, vol. 28, no. 6, 2009, pp. 638-43.
Jurkunas U, Behlau I, Colby K. Fungal keratitis: changing pathogens and risk factors. Cornea. 2009;28(6):638-43.
Jurkunas, U., Behlau, I., & Colby, K. (2009). Fungal keratitis: changing pathogens and risk factors. Cornea, 28(6), pp. 638-43. doi:10.1097/ICO.0b013e318191695b.
Jurkunas U, Behlau I, Colby K. Fungal Keratitis: Changing Pathogens and Risk Factors. Cornea. 2009;28(6):638-43. PubMed PMID: 19512908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fungal keratitis: changing pathogens and risk factors. AU - Jurkunas,Ula, AU - Behlau,Irmgard, AU - Colby,Kathryn, PY - 2009/6/11/entrez PY - 2009/6/11/pubmed PY - 2009/9/9/medline SP - 638 EP - 43 JF - Cornea JO - Cornea VL - 28 IS - 6 N2 - PURPOSE: To describe changes in demographics and pathogens for fungal keratitis cases diagnosed at the Massachusetts Eye and Ear Infirmary. METHODS: Patient demographics, clinical and laboratory findings, treatment and outcomes of 46 cases of culture-proven fungal keratitis diagnosed from January 2004 through November 2007 were compared with 23 cases of fungal keratitis previously collected over a similar period from January 1999 through November 2002. RESULTS: During 2004-2007, the rate of fungal keratitis was 1.0 cases per month, an increase from the baseline rate of 0.5 cases per month during 1999-2002. The proportion of cases caused by filamentous fungi increased from 30% (1999-2002) to 65% (2004-2007) (P = 0.01). Soft contact lens wear accounted for 41% of fungal keratitis cases in 2004-2007, as compared with 17% in 1999-2002. The majority of patients (70%) received oral antifungal treatment in addition to topical amphotericin B and natamycin. Seventeen patients (40%) required therapeutic keratoplasty. Patients with a history of corneal transplant had the highest rate of therapeutic keratoplasties (67%) and had the poorest visual outcome (40% counting fingers or less). In the contact lens group, 94% of patients maintained vision of at least 20/40 and only 12% required surgery to control the infection. CONCLUSIONS: There has been an increase in fungal keratitis in the Boston area and a change in the causative pathogens and risk factors for infection. Filamentous fungi now account for the majority of fungal keratitis cases, whereas yeasts were the predominant pathogen in the past. Soft contact lens wear is currently the most common risk factor for development of fungal keratitis. SN - 1536-4798 UR - https://www.unboundmedicine.com/medline/citation/19512908/Fungal_keratitis:_changing_pathogens_and_risk_factors_ L2 - http://dx.doi.org/10.1097/ICO.0b013e318191695b DB - PRIME DP - Unbound Medicine ER -